Care Gaps

Care Gaps — What's Missing?

Having access to the system is step one. Step two is whether the system delivers the right kind of care. This page looks at the gaps: the imbalance between prevention and crisis response, the disconnect between diagnosis and treatment in mental health, the question of whether substance use treatment is keeping pace with the epidemic, and whether people stay in care long enough for it to matter.

Provenance

Methodological Guardrails

Preventive vs Reactive Care

Every dollar spent on prevention saves multiple dollars downstream. Vaccinations, screenings, well-child visits, and chronic disease management keep people out of ERs and hospitals. But prevention is easy to cut and hard to measure — you never see the heart attack that didn't happen.

SELECT * FROM medicaid.preventive_vs_reactive

Spending Share by Care Type

SELECT
    care_type,
    ROUND(SUM(paid_billions), 2) AS total_paid,
    ROUND(SUM(paid_billions) * 100.0 / (SELECT SUM(paid_billions) FROM medicaid.preventive_vs_reactive), 1) AS pct_of_total
FROM medicaid.preventive_vs_reactive
GROUP BY care_type
ORDER BY total_paid DESC

Beneficiary Trends by Care Type

Mental Health Deep Dive

Mental health is one of the fastest-growing areas of Medicaid spending. But growth in spending doesn't necessarily mean growth in treatment. The key question: are people getting ongoing therapy, or just being assessed and sent home?

[Inference, Medium confidence] If diagnostic evaluations are growing faster than therapy sessions, it means more people are walking through the door but not getting sustained treatment. That's a pipeline problem — the front door is open but the hallway is blocked.

Citation: mh (source medicaid.mental_health_detail).

Spending by Service Type

SELECT * FROM medicaid.mental_health_detail

Beneficiaries by Service Type

Individual Therapy (60 min) — Detail

Substance Use Treatment

The opioid crisis, and substance use disorders more broadly, represent one of the most urgent challenges in Medicaid. [Descriptive, High confidence] Spending is up ~80% since pre-COVID — but whether that is reaching more people or just costing more per person is an inference question.

Citation: su (source medicaid.substance_use_detail) and era patterns in medicaid.era_comparison.

Spending by Service Type

SELECT * FROM medicaid.substance_use_detail

Beneficiaries by Service Type

MAT / Opioid Treatment — Cost per Beneficiary

What's Driving Substance Use Costs?

Aggregate SU cost per beneficiary has been rising. This breakdown shows which service types are responsible — is it residential treatment getting more expensive, MAT medications costing more, or a shift in the mix of services?

SELECT * FROM medicaid.su_cost_by_type

Care Continuity

Getting a first appointment is only the beginning. Effective care — especially for chronic conditions and behavioral health — requires follow-through. Claims per beneficiary is a rough proxy: if someone with a chronic condition only has 1-2 claims per year, they're likely not getting sustained treatment.

Claims per Beneficiary by Category

Mental Health — Annual Trends

SELECT * FROM medicaid.care_continuity

Cost per Beneficiary Over Time

Low claims-per-beneficiary in mental health or substance use is a red flag — people are touching the system but not staying engaged long enough for treatment to work. A single therapy session or one prescription fill is unlikely to produce a lasting outcome. If this number is rising, it's a positive signal that people are staying in care longer.

Reproduce This Page

cd dashboard
export EVIDENCE_SOURCE__medicaid__token="<your_motherduck_token>"
export EVIDENCE_SOURCE__medicaid__database="medicaid"
npm run sources
npm run build
npm run preview
# then open http://localhost:3000/care-gaps